# Prognostic Value of a Low-Cost LDH–Hemoglobin–Albumin Biomarker Panel in Acute Heart Failure: A Real-World Cohort from a Resource-Limited Setting

## TL;DR

This study shows that lactate dehydrogenase (LDH) can predict in-hospital mortality in acute heart failure patients in resource-limited settings where advanced biomarkers are unavailable.

## Contribution

LDH is identified as a practical, independent mortality predictor in acute heart failure when advanced biomarkers are not accessible.

## Key findings

- Elevated LDH levels were independently associated with in-hospital mortality (adjusted odds ratio 2.84).
- Anemia and hypoalbuminemia lost their prognostic significance after adjusting for age, sex, and chronic kidney disease.
- NLR and CALLY index showed nonsignificant trends toward adverse outcomes.

## Abstract

Background: In many low- and middle-income countries, access to advanced cardiac biomarkers such as B-type natriuretic peptide (BNP) and NT-pro BNP remains limited, posing challenges for early risk stratification in patients hospitalized with acute heart failure (AHF). Identifying simple, inexpensive, and universally available laboratory markers with prognostic value is of practical clinical importance. Methods: Consecutive patients (≥18 years) hospitalized with acute heart failure (AHF) between May 2022 and November 2024 were retrospectively analyzed. After exclusion of patients with incomplete outcome data, in-hospital mortality was assessed using logistic regression analysis. Hemoglobin, serum albumin, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and the C-reactive protein–albumin–lymphocyte (CALLY) index were evaluated as potential predictors of in-hospital mortality. Results: A total of 211 patients were included in the mortality analysis, with an in-hospital mortality rate of 10.0%. Patients were stratified by anemia and hypoalbuminemia status, revealing significant differences in unadjusted mortality rates across groups (p = 0.04). However, after adjustment for age, sex, and chronic kidney disease, the prognostic impact of anemia and hypoalbuminemia was attenuated. Elevated LDH levels remained independently associated with in-hospital mortality (adjusted odds ratio 2.84, 95% confidence interval 1.01–8.02). Higher NLR values and lower CALLY index levels showed nonsignificant trends toward adverse outcomes. Conclusions: In this real-world cohort from a resource-limited setting, LDH emerged as a practical and independent predictor of in-hospital mortality in patients with AHF. When access to natriuretic peptides is limited, LDH—supported by routinely available laboratory parameters—may assist early risk stratification and clinical decision-making.